LONG-TERM RESULTS OF POSTEROMEDIAL RELEASE FOR THE TREATMENT OF CONGENITAL CLUBFOOT

Abstract

The aim of the work was to evaluate long-term results of posteromedial release in the treatment of congenital clubfoot. The posteromedial release – which includes capsuloligamentothomy of the tibiotalar and tibio-calcaneal joints from the posterior and medial aspects and “Z” lengthening of the Achilles and posterior tibial muscle tendons with Steindler procedure – has been the basic treatment of choice for many years in cases of congenital clubfoot in the Child Orthopaedic Clinic of the Pomeranian Medical Academy. In some cases transfer of the anterior tibial muscle tendon was also included in that procedure.

Between 1979 and 1990, a total of 135 children were treated with posteromadial release at the author’s institution. Thirty-five patients were excluded from the study because of incomplete medical documentation or because of a possible different origin of the deformity, i.e., subtle spastic cerebral palsy or arthrogryphosis, etc. The study group consisted of 100 patients with 135 clubfeet. At the final follow-up, 46 patients were evaluated with 61 clubfeet. Mean age at the time of surgery was 12.3 months (5–48). All patients had been treated conservatively at the author’s clinic before operative treatment started. Average age of the beginning of the manipulative treatment (followed by cast application in weekly intervals) was 4.3 weeks (1 to 48). Mean follow-up period was 15.7 years (range 20.4–10.1). The patients’ age at the last follow-up ranged from 11 to 21 years old.

The final evaluation based on the criteria of Magone, et. al., gave us the following results: Excellent: 17 feet (28%); Good: 17 feet (28%); Fair: 11 feet (18%); Poor: 16 feet (26%).

Posteromedial release with the Steindler procedure added gives us more than 50% excellent and good results when applied early and with proper pre- and post-operative conservative treatment.